From ICU to hospital-wide: extending central line associated bacteraemia (CLAB) prevention.

AIMS: To decrease hospital-wide central line associated bacteraemia (CLAB) by spreading the prevention programme beyond the intensive care unit (ICU) in a secondary care hospital in Auckland, New Zealand. METHOD: Over 15 months, four general surgical wards, five inpatient units, and surgical theatres adopted the quality improvement initiative, and were followed for a further 15 months. The initiative included central line insertion and maintenance checklists, a central line insertion pack, training in central line care, and a dedicated database. In addition, a checklist to assess the readiness of each new area was developed; data collection and analysis processes embedded, with rapid feedback to staff and in-depth review of all CLAB events. RESULTS: Compliance measures improved significantly (compliance with insertion increased from a mean of 84% to 92% p=0.001; maintenance from 64% to 85%, p=0.002). The absolute numbers of CLAB fell hospital-wide from a mean of 2.3/month to 0.56/month. The rate of CLAB hospital-wide decreased from 7.04/1,000 line days to 1.37/1,000. CONCLUSION: We have demonstrated that the CLAB prevention work proven effective in the ICU can be successfully adapted and expanded to the rest of the hospital. As central lines are increasingly inserted in units outside the ICU, and maintained in general wards, this work provides some useful insights into tackling this larger problem.

Aiming for zero: decreasing central line associated bacteraemia in the intensive care unit.

AIM: To eliminate Central Line Associated Bacteraemia (CLAB) in the Critical Care Complex (CCC)-Intensive Care Unit (ICU) and High Dependency Unit (HDU)-Middlemore Hospital. METHOD: Multifaceted quality improvement programme that included: engagement with ICU leadership and education of ICU staff; the introduction of a CLAB prevention bundle of care through standardised checklists for central line insertion (December 2008) and line maintenance (July 2009); the development of a central line pack; and rapid, visual feedback of results. RESULTS: Absolute numbers of CLAB in the CCC decreased from 14 in 2008, to 4 in 2009 and 1 in the first 6 months of 2010 (despite increase in bed census and a doubling of admissions). The CLAB rate per 1,000 line days decreased from 6.6 to 0.9. The days between CLAB increased from a median of 30 to >100 days, with zero CLAB for 5 of the last 6 months. Mortality for patients with CLAB was 37%, compared with mortality of 13% for all other ICU patients. The conservative cost savings were $200,000 in 2009 and $260,000 in 2010. CONCLUSION: Using an evidenced-based quality improvement approach, it is possible to significantly decrease Central Line Associated Bacteraemia in the Critical Care Complex. In doing so patient morbidity and mortality are reduced and money is saved for other healthcare needs.